We appreciate your concern about the potential for intravascular penetration during epidural steroid injections. In our study, we employed the drawback technique to minimize this risk. While it is true that real-time fluoroscopy with contrast can enhance the detection of intravascular injections, our approach prioritized a balance between efficacy and practicality. According to Visnjevac et al. [
2] in 2015, the use of digital subtraction angiography versus real-time fluoroscopy for detecting intravascular penetration, mention about the anatomic location and the type of needle differed among the four analyzed reports. Three of four studies reported the use of Quincke needles, but varied in gauge. The fourth study reported gauge, but not type of needle. Our study uses the clear anatomical location and 23G Quincke spinal needle (Becton Dickinson S.A., Madrid, Spain) in every patient. Also, Ko et al. [
3] in 2022 report that identifying needle-induced pain during the non-contrast transforaminal epidural steroid injection procedure, when it matches the patient’s chief complaint of radiating pain, is sufficient for accurate nerve root localization. Without greater complication. The drawback technique, combined with careful patient selection and experienced clinicians, helped mitigate the risk of vascular penetration. Additionally, we monitored patients closely for any signs of complications post-procedure, and no adverse events were observed.